Table 3.
Results of derivation and validation studies for pneumonia severity scores.
| Paper | Score | Patients | Age | % male | Lost to followup | Results |
|---|---|---|---|---|---|---|
| BTS 1987 [22] (derivation) | British Thoracic Society Score 1, 2, 3 | 511 patients | 48.4 | 60.5 | 28 lost to followup | Derivation: Score 1 (URB): 87.5% sensitivity, 78.7% specificity Score 2 (CRB): 39.1% sensitivity, 93.9% specificity Score 3 (COUW): 50% sensitivity, 89% specificity |
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| Farr et al. 1991 [23] (validation) | British Thoracic Society Score 1, 2, 3 | 245 patients | 58.9 | 55 | None | Validation: Score 1 (URB): 70% sensitivity, 84.2% specificity, 28.6% PPV, 96.9% NPV, 82.3% overall accuracy Score 2 (CRB): 35% sensitivity, 88.5% specificity, 21.9% PPV, 93.7% NPV, 84% overall accuracy Score 3 (COUW): 42.1% sensitivity, 86.6% specificity, 24.2% PPV, 93.6% NPV, 82.4% overall accuracy |
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| Leroy et al. 1996 [14] | Mortality risk index | 460 patients, 335 derivation, 125 validation | 62.5 | 64.3 | None | Derivation: 62% sensitivity, 92% specificity, 74% PPV Validation: 61% sensitivity, 98% specificity, 92% PPV |
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| Neill et al. 1996 [8] | CURB | 255 patients | 58 | 55 | 6 patients, no consent was obtained | Derivation: CURB: 95% sensitivity, 91% specificity, 22% PPV, 99% NPV BTS 1: 90% sensitivity, 76% specificity, 25% PPV, 99% NPV BTS 2: 65% sensitivity, 88% specificity, 33% PPV, 97% NPV BTS 3: 63% sensitivity, 88% specificity, 32% PPV, 97% NPV |
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| Fine et al. 1997 [11] | Pneumonia severity index | 14199 derivation, 38039 validation | NA | 51 | None | Derivation: PSI area ROC 0.84 Validation: PSI area ROC: MedisGroup cohort 0.83, PORT cohort 0.89 |
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| Lim et al. 2003 [21] | CURB-65, CRB-65 | 1068 patients | 64 | 51.5 | None | Derivation: CURB (>2): 75.4% sensitivity, 68.9% specificity, 20.5% PPV, 96.3% NPV CURB-65 (>3): 68.1% sensitivity, 74.9% specificity, 22.4% PPV, 95.7% NPV CRB-65 (>2): 76.8% sensitivity, 64.3% specificity, 18.6% PPV, 96.3% NPV Validation: CURB (>2): 75% sensitivity, 70.1% specificity, 20.5% PPV, 96.5% NPV CURB-65 (>3): 75% sensitivity, 74.7% specificity, 23.4% PPV, 96.7% NPV CRB-65 (>2): 80% sensitivity, 61.3% specificity, 17.6% PPV, 96.7% NPV |
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| Ewig et al. 2004 [15] | Modified American Thoracic Society Rule | 696 patients | 67.8 | 66 | 21 patients had treatment setting not documented and were excluded | Validation mATS 94% sensitivity, 93% specificity, 49% PPV, 99.5% NPV, 93% overall accuracy BTS I 46% sensitivity, 87% specificity, 20% PPV, 96% NPV, 85% overall accuracy BTS II 53% sensitivity, 83% specificity, 19% PPV, 96% NPV, 81% overall accuracy mBTS 51% sensitivity, 80% specificity, 16% PPV, 96% NPV, 78% overall accuracy |
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| Myint et al. 2006 [24] | SOAR | 195 patients | 77 (median) | 57 | None | Derivation: SOAR (≥2): 81.0% sensitivity, 59.3% specificity, 27.0% PPV, 94.4% NPV CURB (≥2): 81.5% sensitivity, 61.1% specificity, 25.9% PPV, 95.2% NPV CURB-65 (≥3): 81.5% sensitivity, 64.2% specificity, 27.5% PPV, 95.4% NPV CRB-65 (≥2): 85.2% sensitivity, 57.0% specificity, 24.5% PPV, 95.9% NPV |
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| Myint et al. 2007 [27] (derivation) | CURB age | 189 patients | 75 (median) | 56.1 | None | Derivation: CURB age: 81.5% sensitivity, 74.1% specificity, 34.4% PPV, 96% NPV CURB-65: 81.5% sensitivity, 64.2% specificity, 27.5% PPV, 95.4% NPV |
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| Escobar et al. 2008 [25] | Abbreviated Fine Score | 11030 and 6147 patients | 71.3 | 51.2 | None | Derivation: AFFS: area ROC: inhospital mortality: 0.74 and 30-day mortality: 0.75 |
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| Shindo et al. 2008 [26] | A-DROP | 371 patients | 75 | 59.9 | 42 (lack data) | Validation: A-DROP: Area ROC 0.846 (0.790–0.903) CURB-65: Area ROC 0.835 (0.763–0.908) |
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| Myint et al. 2009 [7, 31] (validation) |
CURB-age | 190 patients | 76 (median) | 53 | None | Validation full cohort: CURB age: 50.0% sensitivity, 80.1% specificity, 50.0% PPV, 80.1% NPV CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV Validation for the elderly (>65 years): CURB age: 54.0% sensitivity, 70.6% specificity, 51.9% PPV, 72.3% NPV CURB-65: 64.0% sensitivity, 65.9% specificity, 52.5% PPV, 75.7% NPV |
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| Myint et al. 2009 [7, 31] (derivation) |
CURSI, CURASI | 118 | 75 (median) | 51.7 | None | Only 1 patient died during hospital stay and the patient was scored severe by CURSI, CURASI, and CURB-65 |
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| Rello et al. 2009 [28] | PIRO score | 529 patients | NA | NA | None | Derivation: PIRO: 86% sensitivity, 79% specificity, 61% PPV, 93% NPV, area ROC 0.88 |
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| Liapikou et al. 2009 [6] | IDSA/ATS 2007 | 2391 patients | 66.7 | 61.4 | 289 missing data | Validation: ATS 2001: 58% sensitivity, 88% specificity |
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| Uchiyama et al. 2010 [29] | PARB | 243 patients | NA | NA | None | Derivation: PARB: 36% sensitivity, 99% specificity, area ROC 0.8705, accuracy 91.9% |
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| Myint et al. 2010 [30] (validation) |
CURSI, CURASI | 190 patients | 76 (median) | 53 | None | Validation full cohort: CURSI: 61.1% sensitivity, 72.1% specificity, 46.5% PPV, 82.4% NPV CURASI: 59.3% sensitivity, 72.8% specificity, 46.4% PPV, 81.8% NPV CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV Validation for the elderly (>65 years): CURSI: 62.0% sensitivity, 69.4% specificity, 54.4% PPV, 75.6% NPV CURASI: 60.0% sensitivity, 70.6% specificity, 54.5% PPV, 75.0% NPV CURB-65: 64.0% sensitivity, 65.9% specificity, 52.5% PPV, 75.7% NPV |
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| Musonda et al. 2011 [32] | CARSI, CARASI | 190 patients | 76 (median) | 53 | None | Derivation: CARSI: 40.7% sensitivity, 87.5% specificity, 56.4% PPV, 78.8% NPV, 0.641 area ROC CARASI: 38.9% sensitivity, 89.0% specificity, 58.3% PPV, 78.6% NPV, 0.639 area ROC CURB-65: 59.3% sensitivity, 75.7% specificity, 49.2% PPV, 82.4% NPV, 0.675 area ROC |
URB: urea, respiratory rate, blood pressure; CRB: confusion, respiratory rate, blood pressure; COUW: confusion, oxygen, urea, white cell count; PPV: positive predictive value; NPV: negative predictive value.